This chapter introduces electrophysiological and electrical principles that underlie deep brain stimulation (DBS), with the purpose of facilitating effective and efficient postoperative programming. In order to comprehensively explore the effects of DBS, the entire set of electrode configurations and stimulation parameters would have to be systematically tested. There is considerable evidence that DBS-related changes in neurotransmitters and neuromodulators are unlikely to fully explain the DBS mechanisms of action. The control of the stimulating current is quite different in constant-current versus constant-voltage devices. The electrical charge generated during the DBS pulse dissipates with distance from the electrode. The stimulation parameters and electrode configurations can be used to control the spatial extent and number of axons excited by the DBS pulse. Excessive stimulation can lead to tissue damage by several mechanisms. In addition, unbalanced charges can create other reactive chemical species that can cause tissue damage.

This chapter discusses the evaluation for and management of Vim deep brain stimulation (DBS) in the essential tremor (ET) patient. It is important to document the tasks that are of particular importance to the patient, such as writing, and putting on make-up. The majority of DBS clinicians initiate programming two to four weeks after Vim DBS lead implantation. Prior to initiating DBS programming, electrode impedance measurements should be performed to confirm integrity of the DBS system and its connections, and also to document a baseline measurement for future reference during troubleshooting. Stimulation-related adverse effects for DBS in the region of the Vim include paresthesia, dysarthria, incoordination, pain, asthenia, abnormal thinking, and headache. Often, stimulation parameters remain remarkably stable over time and provide excellent tremor suppression for many years. The neurostimulator can be turned off by the patient using the patient programmer.

This chapter serves as a brief guide for clinicians taking care of patients with implanted deep brain stimulation (DBS) systems. It describes the different hardware components of available DBS systems that are relevant to the programmer. In order to understand the fundamentals of programming, it is important to be familiar with the devices used for DBS. In order to optimize the effects of DBS by providing maximal symptom suppression without unacceptable stimulation-induced adverse effects, clinicians can modify the electrode configuration and the electrical parameters used to deliver stimulation. Most centers wait 3-4 weeks after implantation of the DBS leads to initiate stimulation. Record keeping is an essential aspect of DBS programming, and most clinicians use dedicated forms to organize their programming data. At the end of each programming session, the clinician will document the final stimulation parameters and therapy measurements.